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Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"1 through 10","median_amount":162100.91,"10th_percentile":162100.91,"90th_percentile":162100.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"1 through 10","median_amount":22400.0,"10th_percentile":22400.0,"90th_percentile":22400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"1 through 10","median_amount":48107.48,"10th_percentile":48107.48,"90th_percentile":48107.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"1 through 10","median_amount":13521.97,"10th_percentile":13521.97,"90th_percentile":13521.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"1 through 10","median_amount":41405.0,"10th_percentile":41405.0,"90th_percentile":41405.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"1 through 10","median_amount":8600.0,"10th_percentile":8600.0,"90th_percentile":18750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"1 through 10","median_amount":39524.0,"10th_percentile":39524.0,"90th_percentile":39524.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"1 through 10","median_amount":57644.85,"10th_percentile":57644.85,"90th_percentile":57644.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"1 through 10","median_amount":107039.93,"10th_percentile":107039.93,"90th_percentile":107039.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"1 through 10","median_amount":28000.0,"10th_percentile":28000.0,"90th_percentile":150825.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"1 through 10","median_amount":70517.72,"10th_percentile":70517.72,"90th_percentile":70517.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"1 through 10","median_amount":64747.76,"10th_percentile":64747.76,"90th_percentile":64747.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"1 through 10","median_amount":10881.0,"10th_percentile":10881.0,"90th_percentile":10881.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"1 through 10","median_amount":6000.0,"10th_percentile":6000.0,"90th_percentile":6000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"1 through 10","median_amount":2100.0,"10th_percentile":2100.0,"90th_percentile":2100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"1 through 10","median_amount":2000.0,"10th_percentile":2000.0,"90th_percentile":2000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"1 through 10","median_amount":24755.0,"10th_percentile":24755.0,"90th_percentile":24755.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"1 through 10","median_amount":65264.66,"10th_percentile":65264.66,"90th_percentile":65264.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"1 through 10","median_amount":41722.73,"10th_percentile":41722.73,"90th_percentile":41722.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"1 through 10","median_amount":12000.0,"10th_percentile":12000.0,"90th_percentile":12000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"1 through 10","median_amount":11031.0,"10th_percentile":11031.0,"90th_percentile":11031.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"1 through 10","median_amount":16000.0,"10th_percentile":8750.0,"90th_percentile":20000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"1 through 10","median_amount":61280.13,"10th_percentile":61280.13,"90th_percentile":61280.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"1 through 10","median_amount":35035.0,"10th_percentile":35035.0,"90th_percentile":35035.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"1 through 10","median_amount":22560.0,"10th_percentile":22560.0,"90th_percentile":22560.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"1 through 10","median_amount":18750.0,"10th_percentile":18750.0,"90th_percentile":20000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm and EX SoCal excl Paramount-CT MRI-Carve Out-Per Unit: 159] [HD Comm and EX SoCal excl Paramount-Dialysis-Carve Out-Per Unit: 509] [HD Comm and EX SoCal excl Paramount-ICU CCU-Per Diem: 2577] [HD Comm and EX SoCal excl Paramount-Intermediate ICU CCU-Per Diem: 2068] [HD Comm and EX SoCal excl Paramount-Lesser Than Charges paid at %: 100] [HD Comm and EX SoCal excl Paramount-Med Surg-Per Diem: 1989] [HD Comm and EX SoCal excl Paramount-Vent-Carve Out-Per Unit: 159]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Anthem Bc","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All CA Comm-Dialysis-Carve Out-Per Unit: 571] [HD All CA Comm-ICU CCU-Per Diem: 3864] [HD All CA Comm-Intermediate ICU CCU-Per Diem: 3485] [HD All CA Comm-Med Surg-Per Diem: 3485] [HD All CA Comm-Rehabilitation-Per Diem: 3485] [SoCal-Dialysis-Carve Out-Per Unit: 471] [SoCal-High Cost Drugs-Carve Out (%BC): 25] [SoCal-ICU CCU-Per Diem: 2081] [SoCal-Intermediate ICU CCU-Per Diem: 2081] [SoCal-Level of Care-Rev Code 169-Per Diem: 1515] [SoCal-Med Surg-Per Diem: 1894] [SoCal-Rehabilitation-Per Diem: 1515]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Shield Califor","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD COMM-Dialysis-Carve Out-Per Unit: 683] [HD COMM-ICU CCU-Per Diem: 3281] [HD COMM-Intermediate ICU CCU-Per Diem: 3281] [HD COMM-Lesser Than Charges paid at %: 75.3] [HD COMM-Med Surg-Per Diem: 3281] [HD COMM-Psychiatric-Per Diem: 3281] [HD COMM-Rehabilitation-Per Diem: 3281]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cal Optima","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD All-Detoxification-Per Diem: 2194] [HD All-Hospice-Per Diem: 2194] [HD All-ICU CCU-Per Diem: 2194] [HD All-Intermediate ICU CCU-Per Diem: 2194] [HD All-Leave of Absence-Per Diem: 2194] [HD All-Lesser Than Charges paid at %: 100] [HD All-Med Surg-Per Diem: 2194] [HD All-Nursery ICU-Per Diem: 2194] [HD All-Nursery-Per Diem: 2194] [HD All-Psychiatric-Per Diem: 2194] [HD All-Rehabilitation-Per Diem: 2194] [HD All-Subacute-Per Diem: 1069] [HD Man Med Non Ex and Ex-Dialysis-Carve Out-Per Unit: 300] [HD Man Med Non Ex and Ex-ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Intermediate ICU CCU-Per Diem: 2000] [HD Man Med Non Ex and Ex-Lesser Than Charges paid at %: 100] [HD Man Med Non Ex and Ex-Level of Care-Rev Code 169-Per Diem: 1250] [HD Man Med Non Ex and Ex-Med Surg-Per Diem: 2000] [Medicare Advantage and CMC-Detoxification-Per Diem: 2194] [Medicare Advantage and CMC-Hospice-Per Diem: 2194] [Medicare Advantage and CMC-ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Intermediate ICU CCU-Per Diem: 2194] [Medicare Advantage and CMC-Leave of Absence-Per Diem: 2194] [Medicare Advantage and CMC-Lesser Than Charges paid at %: 100] [Medicare Advantage and CMC-Med Surg-Per Diem: 2194] [Medicare Advantage and CMC-Nursery ICU-Per Diem: 2194] [Medicare Advantage and CMC-Nursery-Per Diem: 2194] [Medicare Advantage and CMC-Psychiatric-Per Diem: 2194] [Medicare Advantage and CMC-Rehabilitation-Per Diem: 2194]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kaiser Permanente Mcd","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD SoCal Comm MA-Dialysis-Carve Out-Per Unit: 572] [HD SoCal Comm MA-High Cost Drugs-Carve Out (%BC): 35] [HD SoCal Comm MA-ICU CCU-Per Diem: 2259] [HD SoCal Comm MA-Intermediate ICU CCU-Per Diem: 2143] [HD SoCal Comm MA-Lesser Than Charges paid at %: 100] [HD SoCal Comm MA-Med Surg-Per Diem: 2044]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prospect Medical Gr","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Comm-Dialysis-Carve Out-Per Unit: 442] [HD Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [HD Comm-ICU CCU-Per Diem: 2704] [HD Comm-Intermediate ICU CCU-Per Diem: 2704] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [HD Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [HD Comm-Med Surg-Per Diem: 2704] [HD Comm-Rehabilitation-Per Diem: 2704] [MediCal-Dialysis-Carve Out-Per Unit: 442] [MediCal-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [MediCal-ICU CCU-Per Diem: 2080] [MediCal-Intermediate ICU CCU-Per Diem: 2080] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [MediCal-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [MediCal-Med Surg-Per Diem: 2080] [MediCal-Rehabilitation-Per Diem: 2080] [Medicare Adv Dual CMC Comm-Dialysis-Carve Out-Per Unit: 442] [Medicare Adv Dual CMC Comm-HCD exceed 500 per dose per day reimbursed 30 percent of billed charges-Carve Out (%BC): 30] [Medicare Adv Dual CMC Comm-ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Intermediate ICU CCU-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1122] [Medicare Adv Dual CMC Comm-Level of Care-Rev Code 0190, 0191, 0192, 0193, 0194, 0199-Per Diem: 1226] [Medicare Adv Dual CMC Comm-Med Surg-Per Diem: 2305] [Medicare Adv Dual CMC Comm-Rehabilitation-Per Diem: 2305]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"St. Joseph Hospital","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medicare-Dialysis-Carve Out-Per Unit: 550] [Medicare-High Cost Drugs-Carve Out (%BC): 35] [Medicare-ICU CCU-Per Diem: 2379] [Medicare-Intermediate ICU CCU-Per Diem: 2270] [Medicare-Level of Care-Rev Code 194-Per Diem: 1300] [Medicare-Med Surg-Per Diem: 2256] [Medicare-Subacute-Per Diem: 950]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[HD Commercial-Detoxification-Per Diem: 2200] [HD Commercial-Hospice-Per Diem: 2200] [HD Commercial-ICU CCU-Per Diem: 2400] [HD Commercial-Intermediate ICU CCU-Per Diem: 2400] [HD Commercial-Lesser Than Charges paid at %: 100] [HD Commercial-Med Surg-Per Diem: 2200] [HD Commercial-Nursery ICU-Per Diem: 2200] [HD Commercial-Nursery-Per Diem: 2200] [HD Commercial-Psychiatric-Per Diem: 2200] [HD Commercial-Rehabilitation-Per Diem: 2200] [HD Commercial-Subacute-Per Diem: 950] [HD Med Adv-Lesser Than Charges paid at %: 100] [HD Med Adv-Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov:]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}]}